Healthcare Provider Details

I. General information

NPI: 1982536967
Provider Name (Legal Business Name): MRS. BRIANNA WINKIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3774 HOLLYWOOD RD
SAINT JOSEPH MI
49085-9550
US

IV. Provider business mailing address

3774 HOLLYWOOD RD
SAINT JOSEPH MI
49085-9550
US

V. Phone/Fax

Practice location:
  • Phone: 269-428-2779
  • Fax:
Mailing address:
  • Phone: 269-428-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008538
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: